Organization
CG-DSA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDI TURNER (LICENSING AND CONTRACTS COORDINATOR)
(800) 299-5161
Entity
Organization
Contact information
Practice address
1102 W MILL ST, ANGOLA, IN 46703-1344
(260) 833-4208
Mailing address
4800 OVERTON PLZ STE 440, FORT WORTH, TX 76109-4435
(800) 299-5161
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
05/25/2022
Last updated
05/25/2022
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